Antibiotic — Oxazolidinone Pregnancy: There are limited data from the use of linezolid in pregnant women; animal studies have shown reproductive toxicity and a potential risk for humans exists. Should not be used during pregnancy unless clearly necessary, i.e. only if the potential benefit outweighs the theoretical risk. Breast-feeding should be discontinued prior to and throughout administration. In animal studies linezolid caused a reduction in fertility.

Linezolid (Burns — Vancomycin-Resistant/Refractory MRSA)

Brand names: Zyvox

Linezolid is an oxazolidinone antibacterial reserved in burns for resistant or refractory MRSA infection, including where glycopeptides are unsuitable or have failed.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 600 mg twice daily

Route: Intravenous infusion over 30 to 120 minutes. May be used as initial therapy and switched to either oral presentation when clinically indicated — no dose adjustment is required, as linezolid has an oral bioavailability of approximately 100%

Frequency: Twice daily

Source: UK SPC (eMC) for Linezolid 2mg/ml Solution for Infusion, §4.2 (https://www.medicines.org.uk/emc/product/7300/smpc). The SPC has no burns-specific indication; 600 mg twice daily is the SPC dose for complicated skin and soft tissue infections and for nosocomial/community-acquired pneumonia — clinician to confirm against local burns/MRSA protocol. DURATION: 10-14 consecutive days for nosocomial and community-acquired pneumonia; duration for complicated skin and soft tissue infections is dependent on the pathogen, site and severity of infection and clinical response. MAXIMUM TREATMENT DURATION IS 28 DAYS — safety and effectiveness beyond 28 days have not been established. No increase in dose or duration is required for infections associated with concurrent bacteraemia. Elderly: no dose adjustment required. Hepatic impairment: no dose adjustment required, but limited clinical data — use only when the anticipated benefit outweighs the theoretical risk. §4.4 advises weekly monitoring of complete blood counts (myelosuppression risk, related to duration of treatment). PAEDIATRIC: the UK SPC states the safety and efficacy of linezolid in children (<18 years old) has not been established and no recommendation on a posology can be made; US labelling (DailyMed, Hikma, https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9eef61e8-dd27-4b8b-a3d3-e5100af2bcee) instead states 10 mg/kg IV or oral every 8 hours from birth through 11 years for complicated skin and skin structure infections (14 to 28 days). Because the UK SPC and the US label conflict, no structured paediatric dose is recorded here — verify against a children's formulary.

Dose adjustments

Renal

No dose adjustment is required, including in severe renal impairment (CLcr <30 ml/min). However, because of the unknown clinical significance of higher exposure (up to 10-fold) to the two primary metabolites in severe renal insufficiency, use with special caution and only when the anticipated benefit outweighs the theoretical risk. Approximately 30% of a linezolid dose is removed during 3 hours of haemodialysis, so linezolid should be given after dialysis in patients receiving such treatment. No experience in patients undergoing CAPD or alternative renal replacement therapies other than haemodialysis.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to linezolid or to any of the excipients
Patients taking any medicinal product which inhibits monoamine oxidases A or B (e.g. phenelzine, isocarboxazid, selegiline, moclobemide), or within two weeks of taking any such medicinal product
Unless facilities are available for close observation and monitoring of blood pressure: patients with uncontrolled hypertension, phaeochromocytoma, carcinoid, thyrotoxicosis, bipolar depression, schizoaffective disorder or acute confusional states
Unless facilities are available for close observation and monitoring of blood pressure: patients taking serotonin re-uptake inhibitors, tricyclic antidepressants, 5-HT1 receptor agonists (triptans), directly and indirectly acting sympathomimetics (including adrenergic bronchodilators, pseudoephedrine, phenylpropanolamine), vasopressive agents (e.g. epinephrine, norepinephrine), dopaminergic agents (e.g. dopamine, dobutamine), pethidine or buspirone
Breast-feeding should be discontinued prior to and throughout administration

Side effects

Common: diarrhoea (8.4%), headache (6.5%), nausea (6.3%), vomiting (4.0%)
Common: candidiasis (oral and vaginal) and fungal infections; taste perversion (metallic taste); abdominal pain, constipation, dyspepsia
Common/uncommon: anaemia, leucopenia, neutropenia, thrombocytopenia, eosinophilia; myelosuppression and sideroblastic anaemia (frequency not known)
Uncommon/rare: hyponatraemia, lactic acidosis, convulsions, hypoaesthesia, paraesthesia; optic neuropathy/neuritis, blurred vision, loss of vision; peripheral neuropathy
Not known: serotonin syndrome; anaphylaxis; bullous disorders including Stevens-Johnson syndrome and toxic epidermal necrolysis, angioedema; antibiotic-associated (including pseudomembranous) colitis

Interactions

Monoamine oxidase inhibitors — linezolid is a reversible, nonselective inhibitor of monoamine oxidase; concomitant use (or use within two weeks) is contraindicated (US label §7.1; UK SPC §4.3)
Serotonergic agents (SSRIs, tricyclic antidepressants, triptans, pethidine, buspirone) — potential for serotonin syndrome; monitor (US label §7.2, §5.3)
Adrenergic agents (directly and indirectly acting sympathomimetics, vasopressors such as epinephrine/norepinephrine, dopaminergic agents) — potential for elevation of blood pressure; monitor blood pressure (US label §7.2, §5.6)
Medicinal products that may decrease haemoglobin levels, depress blood counts or adversely affect platelet count or function — close monitoring of blood counts recommended (UK SPC §4.4)
UK SPC §4.5 was not retrieved in this bundle — verify the full interaction section

Clinical monograph

How it works

It inhibits bacterial protein synthesis by binding the 23S ribosomal RNA of the 50S subunit and preventing formation of the initiation complex, giving activity against Gram-positive organisms including MRSA and VRE.

Prescribing in practice

It is a reversible monoamine oxidase inhibitor and can precipitate serotonin syndrome with serotonergic drugs and hypertensive reactions with sympathomimetics or tyramine-rich foods — review medications carefully before use.
Prolonged courses cause myelosuppression (especially thrombocytopenia) and optic and peripheral neuropathy, so limit duration and avoid extended treatment.
Reserve for confirmed or strongly suspected resistant Gram-positive infection to preserve activity and limit toxicity.

Monitoring

Monitor full blood count regularly during therapy and review courses promptly, with assessment of visual symptoms if treatment is prolonged.

Counselling the patient

Avoid large amounts of tyramine-rich foods such as mature cheese, and tell the team about all other medicines including antidepressants.
Report any visual changes, persistent numbness or tingling, or unusual bruising or bleeding.

Evidence & guidelines

MHRA and the SPC highlight linezolid-associated blood disorders and optic neuropathy with prolonged use, and its monoamine-oxidase-inhibitor interactions.

Reference: MHRA Drug Safety Update (Linezolid); BBA Burns Infection Guidelines; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators